Simultaneous computerised activation of the primary percutaneous coronary intervention pathway reduces out-of-hours door-to-balloon time but not mortality

Background: In 2009 activation of out of hours (OOH) primary percutaneous coronary intervention (PPCI) in our institution changed fromseparate telephone calls to a simultaneous computerised alert. We assessed the impact of this protocol change on door- to-balloon (DTB) time, in hospital and 1 year mortality. Methods: Retrospective survey of our Myocardial Ischaemia National Audit Project (MINAP) database. OOH patients were categorised -pre- (Group 1) and post-(Group 2) introduction of the computerised alert protocol. Results: OOH PPCIwas performed for 793 patients (mean age 61, 73.4% male)-295 in Group 1 and 498 in Group 2. Median DTB times were 92 min (interquartile range [IQR] 75-111) for Group 1 and 76 min (IQR 64-97) for Group 2 (p < 0.0001). Forty-eight percent achieved DTB in <= 90 min in Group 1 compared to 70% in Group 2 (p < 0.0001). Computerised alert was associated with a shorter DTB time on multivariate analysis (beta coefficient- 0.09, p = 0.03 for linear regression and OR 2.8, 95% CI 1.6-5.0, p < 0.0001 for logistic regression). In hospitalmortalitywas 4.1% in Group 1 and 5% in Group 2 (p = 0.60). All-cause mortality at 1 year was 6.1% in Group 1 and 9.9% in Group 2 (p=0.09). Conclusions: Simultaneous computerised activation for OOH PPCI reduced DTB times, increased the number of patients achieving target DTB times but did not affect mortality. (C) 2015 Elsevier Ireland Ltd. All rights reserved.